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Modifier 25 placement

  1. Default Modifier 25 placement
    Medical Coding Books
    Hello everybody,
    I am not an experienced coder and I need clarification on where to place the modifier 25. If a patient comes in for an E/M service and we do an additional service does the modifier go on the E/M visit or the addtional service (an EKG or an injection, etc.)? I thought it was on the addtional service but from other posts I've read it looks as though it is being placed on the e/m visit. Im confused! Obviously! I would appreciate any feedback. Thanks a bunch in advance.

  2. #2
    Columbia, MO
    The 25 modifier is for E&M codes only to distinguish the E&M as over above and beyond the assessment necessary for the procedure.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Modifier 25 only applies to an E/M service:

    • That is above and beyond the procedure performed.
    • That was provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s).
    • That is beyond the usual preoperative and postoperative care associated with the procedure.
    • When a separate history was taken, a separate physical was performed and a separate medical decision was made and is documented in the medical record and -

    A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported. As such a different diagnosis is not required, it may be reported by adding modifier 25 to the appropriate E/M Level.

    But do not use this modifier to report an E/M service that resulted in a decision to perform surgery; see modifier 57!

    Hope this helps you,

    Thank You,

    Purnima S, CPC

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